Medicare Part A & B: Original Medicare Plan

Part A: Inpatient Hospital Insurance

Eligible individuals are automatically enrolled in Part A with no premium. Others apply to the program when they are eligible or pay a monthly premium if they have worked less than 40 quarters (or 10 years) in their lifetime.

Part B: Outpatient / Physician Insurance

To obtain Part B, an eligible individual must enroll at their Social Security office during a specific period and pay a premium that is determined by their annual income. If an individual does not enroll during that period he/she must pay a penalty when he/she does enroll.

How it works

Individuals with Medicare are called beneficiaries. Beneficiaries may go to any doctor, supplier, hospital or other facility that accepts Medicare and is accepting new Medicare beneficiaries. Beneficiaries are responsible for the deductible and coinsurance for most services. The deductible is the amount a beneficiary must pay before Medicare begins to pay for services and supplies covered under the program. Coinsurance is the share of the cost for services that the beneficiary is responsible for after the deductible is met, normally 20 percent. To help pay for some of the health care costs that the Original Medicare Plan doesn’t cover, beneficiaries may choose to purchase Medicare supplemental health insurance (Medigap policy). They may also choose to enroll in a Medicare Prescription Drug Plan (Medicare Part D) to receive prescription drug benefits.

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